Gold injections: Can they treat rheumatoid arthritis?

Gold treatments were one of the earliest treatments for rheumatoid arthritis going back at least 75 years.

There is no cure for rheumatoid arthritis (RA). Medications can slow down the disease, while complementary therapies can help people cope with the joint pain and stiffness, chronic fatigue, and other symptoms, such as low-grade fevers and dry skin and eyes.

While gold injections were once praised for their high rates of remission, their use has declined. This is due to potentially severe side effects and the development of stronger and better-tolerated RA medicines.

What are gold injections?

Gold injections are made from a compound called sodium aurothiomalate, which contains gold. Sodium aurothiomalate belongs to a class of drugs called disease-modifying antirheumatic drugs, or DMARDs.

DMARDs are known for their inflammation-blocking qualities. If inflammation in the body is not blocked, it can cause the joints and tissues to wear down to the point of disability in just a few years.

Like other DMARDs, gold injections reduce the immune system's response. As a result, they should be used with care.

As these medications suppress the immune system to stop inflammation, they also increase the risk of infection. It is therefore important for people to take care to avoid infections, get treated quickly for symptoms of a possible infection, and discuss the use of any live vaccines with their doctors.

Treating RA with gold

Gold injections may decrease the inflammation of rheumatoid arthritis.

Gold injections have long been used to treat RA and other inflammatory joint diseases. They have previously been proven successful for many people with RA.

These injections are not pain relievers, but they decrease pain because they decrease inflammation. They may also help in managing morning joint stiffness and swelling associated with RA.

Gold treatment was once the norm for treating moderate to severe RA. Its use goes back to the 1920s when gold compounds were treatments for tuberculosis.

Researchers once thought that RA and tuberculosis were related. Eventually, that theory was debunked, and the idea that gold could treat RA and provide significant symptom relief was confirmed.

The anti-inflammatory properties of gold compounds are unknown. However, there has been enough evidence to confirm that gold can inhibit behavior of substances responsible for production of antibodies and the release of inflammatory cytokines.

Due to the number and severity of side effects that they cause, gold treatments are now rarely used to treat RA and other inflammatory conditions. Doctors are prescribing other DMARDs instead, including methotrexate, which is considered safer.

Previous research has shown gold injections to be just as effective as methotrexate, according to a historical report of RA treatments in the medical journal, JSM Arthritis. Although rarely prescribed, gold therapy remains the most effective treatment for some people.

How are gold treatments administered?

Gold injections are injected into a muscle, usually the buttock, by a medical professional. Individuals need to lie down during injection and wait at least 10 minutes before sitting up or standing to avoid lightheadedness.

Dosage depends on the person's medical condition, the severity of symptoms, and their response to treatment. Injections are given once a week until there is improvement. After that, they are given twice a month or less. If RA symptoms return or worsen, then an individual will go back to having the injections weekly.

Gold injection treatment must be used regularly for the best results. It can take up to 3 months before people see significant results. People should inform their doctors if symptoms do not get better or worsen after this time.

Side effects and risks

Just like other DMARDs, gold injections may cause side effects, including:

Side effects of gold injections may include lightheadedness, nausea, and dizziness.

dizziness

nausea and vomiting

flushing and sweating

lightheadedness

increased joint pain at the start of treatment

kidney disease

People should inform their doctors of any serious side effects, including any of the following:

Current RA treatments

The drug methotrexate has been used since the 1940s as a cancer treatment. Following a 1985 report in the New England Journal of Medicine, doctors began using it to treat RA.

This research showed that methotrexate was effective for treating RA symptoms, including pain and swelling. It was not long before it replaced gold as the standard treatment for RA and inflammatory arthritis.

Methotrexate may be one of the safest RA drugs, but it can still cause side effects. These include raised levels of liver enzymes, which may cause long-term liver problems, oral ulcers, and gut symptoms. Taking folic acid on a daily basis can help reduce these side effects, however.

Some people, especially pregnant women, should not take methotrexate. People should always discuss use of the drug with a doctor to weigh up the risks and benefits.

If methotrexate does not provide adequate symptom relief on its own, doctors may prescribe it in combination with other medications. Options include other DMARDs, such as sulfasalazine doxycycline and hydroxychloroquine.

For people who do not respond to DMARDs, either alone or in combination with other medications, doctors may consider biologic drugs. Biologics hinder over-reactive immune system responses, which are the main culprits for heightened inflammatory responses.

Biologics include TNF inhibitors, such as adalimumab, that block TNF, a protein that encourages inflammation.

The future of gold treatment

Even though the use of gold compounds to treat RA has declined due to the introduction of newer DMARDs and biologic therapies, some researchers are looking to reintroduce it.

Researchers who have studied the anti-inflammatory qualities of metallic gold have reported in the Journal of Inflammation about the unique effect that gold compounds have on inflammation. Their research could potentially lead to new therapies involving the use of metallic gold implants to treat RA and other inflammatory diseases.

Reviewing the use of old therapies is not a new concept. Newer studies on gold compounds are looking at more cost-effective ways to better manage the inflammatory process with acceptable side effects.

Researchers also want to take advantage of gold treatments for their antibacterial and antiviral properties. Moreover, the future use of gold therapy in treating cancer may be promising.

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